Depression, Anxiety and Perceived Stigma among Caregivers of Adults with Drug-Resistant Tuberculosis in Rivers State, Nigeria

Abstract

Aims: To determine the prevalence and independent determinants of depression, anxiety, and perceived stigma among informal caregivers of adults with drug-resistant tuberculosis (DR-TB) in Rivers State, Nigeria, to inform targeted psychosocial interventions. Study Design: Descriptive cross-sectional study. Place and Duration of Study: Drug-resistant tuberculosis treatment centre in Port Harcourt, Rivers State, Nigeria, between January 2024 and June 2025. Methodology: Informal caregivers (aged ≥18 years) providing unpaid support for ≥1 month to adults (aged ≥18 years) with confirmed DR-TB were consecutively sampled (n=220). A structured interviewer-administered questionnaire assessed socio-demographics, caregiving burden, depression using the Patient Health Questionnaire-9, anxiety using Generalized Anxiety Disorder-7, and perceived stigma using the 12-item Explanatory Model Interview Catalogue Community Stigma Scale. Bivariate and multivariable logistic regression identified associations (P<0.05 significance), conducted on IBM SPSS version 31.0. Results: Participants were mainly female (64.5%; mean age 42.3±11.2 years) with low income (61.8%). Depression prevalence was 50.9%, anxiety 47.3%, and high perceived stigma 57.3%. Independent predictors included female gender (adjusted odds ratio [AOR] 2.1-2.8, all P<0.05), low income (<₦50,000 [<US$34.40]); AOR 1.9-2.4, P<0.05), and caregiving duration >6 months (AOR 1.7-2.2, P<0.05). Conclusion: Caregivers faced a high psychosocial burden from DR-TB caregiving, driven by gender, economic, and caregiving duration factors. These findings underscore the need for integrating psychosocial support into TB control frameworks, noting that the cross-sectional nature of the study limits any inference to causality, and the findings were based on screening instruments rather than clinical diagnoses. It is recommended that routine mental health screening and support programmes be included in TB control efforts to enhance adherence and reduce defaults; also, future longitudinal studies will elucidate any causal inferences.